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Pseudo-Outbreak of Multiresistant Pseudomonas aeruginosa in a Hematology Unit

Published online by Cambridge University Press:  02 January 2015

Paul E. Verweij ,
Diana Bijl ,
Willem J.G. Melchers ,
Ben E. De Pauw ,
Jacques F.G.M. Meis ,
Jacomina A.A. Hoogkamp-Korstanje  and
Andreas Voss
Paul E. Verweij*
Affiliation:
Departments of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands
Diana Bijl
Affiliation:
Departments of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands
Willem J.G. Melchers
Affiliation:
Departments of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands
Ben E. De Pauw
Affiliation:
Hematology, University Hospital Nijmegen, Nijmegen, The Netherlands
Jacques F.G.M. Meis
Affiliation:
Departments of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands
Jacomina A.A. Hoogkamp-Korstanje
Affiliation:
Departments of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands
Andreas Voss
Affiliation:
Departments of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands
*
Department of Medicine, Hope Hospital, Eccles Old Rd, Salford, M6 8HD, United Kingdom
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Abstract

Objective:

To describe the investigation of a pseudo-outbreak of multiresistant Pseudomonas aeruginosa fecal colonization in a hematology unit.

Design:

Retrospective chart review; prospective environmental sampling and observation of stool culture technique; genotyping by random arbitrary primer polymorphic DNA polymerase chain reaction (RAPD-PCR).

Setting:

An academic tertiary-care hospital.

Patients:

Between August and October 1994, P aeruginosa resistant to imipenem, ceftazidime, ciprofloxacin, and all aminoglycosides was isolated from surveillance stool cultures from 10 neutropenic patients cared for in the hematology unit. P aeruginosa, with an identical susceptibility pattern, was isolated from three patients admitted to the same unit in the year before the “outbreak.” Two months before the outbreak, 12 healthcare workers had been added to the staff.

Results:

Observation of stool sampling techniques as performed by healthcare workers revealed that samples for surveillance cultures were taken from feces in the toilet. When the proper sampling technique was used, P aeruginosa was not isolated from stool samples from 8 of 10 patients with previously positive cultures. P aeruginosa also was isolated from two wash basins, toilet flushing water, and a toilet brush. Genotyping by RAPD-PCR showed that the isolate from the toilet flushing water was identical to the P aeruginosa strains of eight patients from the outbreak.

Conclusions:

This pseudo-outbreak emphasizes the importance of proper sampling techniques and that periodic observation may be necessary to verify proper sampling techniques.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 2 , February 1997 , pp. 128 - 131
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Morrison, AJ, Wenzel, RP. Epidemiology of infections due to Pseudomonas aeruginosa . Rev Infect Dis 1984;6:627S–642S.CrossRefGoogle ScholarPubMed
2. Lechi, A, Arosio, E, Pancera, P, et al. Pseudomonas septicaemia. A review of 60 cases observed in a university hospital. J Hosp Infect 1984;5:29–37.CrossRefGoogle ScholarPubMed
3. Shooter, RA, Cooke, EM, Gaya, H, et al. Food and medicaments as possible sources of hospital strains of Pseudomonas aeruginosa . Lancet 1969;i:1227–1229.Google Scholar
4. Kolmos, HJ, Thuesen, B, Nielsen, SV, Lohmann, M, Kristoffersen, K, Rosdahl, VT. Outbreak of infection in a burns unit due to Pseudomonas aeruginosa originating from contaminated tubing used for irrigation of patients. J Hosp Infect 1993;24:11–21.Google Scholar
5. Falkiner, FR, Jacoby, GA, Keane, CT, McCann, SR. Amikacin, gentamicin and tobramycin resistant Pseudomonas aeruginosa in a leukemic ward. Epidemiology and genetic studies. J Hosp Infect 1982;3:253–261.CrossRefGoogle Scholar
6. Van Belkum, A. Genetic typing of medically important non-viral microorganisms by polymerase chain reaction-mediated DNA fingerprinting. Clin Microbiol Rev 1994;7:174–184.CrossRefGoogle Scholar
7. Verweij, PE, Van Belkum, A, Melchers, WJG, Voss, A, Hoogkamp-Korstanje, JAA, Meis, JFGM. Interrepeat fingerprinting of third generation cephalosporin resistant Enterobacter cloacae isolated during an outbreak in a neonatal intensive care unit. Infect Control Hosp Epidemiol 1995;16:25–29.CrossRefGoogle Scholar
8. Hoogkamp-Korstanje JAA, , Meis, JFGM, Kissing, J, Van der Laag, J, Melchers, WJG. Risk of cross-colonization and infection by Pseudomonas aeruginosa in a holiday camp for cystic fibrosis patients. J Clin Microbiol 1995;33:572–575.CrossRefGoogle Scholar
9. Verweij, PE, Geven, WB, Van Belkum, A, Meis, JF. Cross-infection with Pseudomonas aeruginosa in a neonatal intensive care unit characterized by polymerase chain reaction fingerprinting. Pediatr Infect Dis J 1993;12:1027–1029.CrossRefGoogle Scholar
10. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Document M2-A4, Vol 10, No 7. Villanova, PA: NCCLS; 1990.Google Scholar
11. Sellick, JA. The use of statistical process control charts in hospital epidemiology. Infect Control Hosp Epidemiol 1993;14:649–656.Google Scholar
12. Weinstein, RA, Stamm, WE. Pseudoepidemics in hospital. Lancet 1977;2:862–864.Google Scholar
13. Heard, S, Lawrence, S, Holmes, B, Costas, M. A pseudo-outbreak of Pseudomonas on a special care baby unit. J Hosp Infect 1990;16:59–65.Google Scholar
14. Tokars, JL, McNiel, MM, Tablan, OC, et al. Mycobacterium gordonae pseudo-infection associated with a contaminated antimicrobial solution. J Clin Microbiol 1990;28:2765–2769.Google Scholar
15. York, MK. Bacillus species pseudobacteremia traced to contaminated gloves used in collection of blood from patients with acquired immunodeficiency syndrome. J Clin Microbiol 1990;28:2114–2116.Google Scholar
16. Panlilo, AL, Beck-Sague, CM, Siegel, JD, et al. Infections and pseudo-infections due to povidone-iodine solution contaminated with Pseudomonas cepacia . Clin Infect Dis 1992;14:1078–1083.CrossRefGoogle Scholar
17. Bradley, SF, Wilson, KH, Rosloniec, MA, Kauffman, CA. Recurrent pseudo-bacteremias traced to a radiometric blood culture device. Infect Control 1987;8:281–283.CrossRefGoogle ScholarPubMed
18. Forman, W, Axelrod, P, St. John, K, et al. Investigation of a pseudo-outbreak of orthopedic infections caused by Pseudomonas aeruginosa . Infect Control Hosp Epidemiol 1994;15:652–657.CrossRefGoogle ScholarPubMed
19. Weems, JJ, Andremont, A, Davis, BJ, et al. Pseudoepidemic of aspergillosis after development of pulmonary infiltrates in a group of bone marrow transplant patients. J Clin Microbiol 1987;25:1459–1462.Google Scholar
20. Boukadida, J, De Montalembert, M, Gaillard, JL, et al. Outbreak of gut colonization by Pseudomonas aeruginosa in immunocom-promised children undergoing total digestive decontamination: analysis by pulsed-field electrophoresis. J Clin Microbiol 1991;29:2068–2071.Google Scholar
21. Favero, MS, Carson, LA, Bond, WW, Petersen, NJ. Pseudomonas aeruginosa: growth in distilled water from hospitals. Science 1971;173:836–838.CrossRefGoogle ScholarPubMed